Closing the productivity gap in public services

From Chris Dillow:

Nick Bloom and colleagues have estimated (pdf) that over a third of the gap in total factor productivity between the UK and US is due to inferior management. Some of this gap might be closed if only managers were more aware of best practice. In this context, the very fact that the UK’s productivity is lower than the G7 average is, in a sense, encouraging. It means we don’t need new innovations to boost productivity; we simply need to learn what the French, Germans and Americans are doing.

This is cheering, partly because it brings together a couple of things that Arbitrary Constant has bashed on about in the last few weeks:

  1. Very little can truly be thought of as ‘innovative’, and knowing how we get from innovative to ‘best practice’ to ‘improvement’ to ‘standard’ in public services is what matters
  2. Clearly related to this, we should never ignore the little things (even if that just means making meetings better)

Making absolutely boring and absolutely needed meetings better

Image via Opaque Design
Image via Opaque Design

I’ve been thinking about the little things a lot lately. Rather than trying to make big leaps in changing anything – public services, organisational cultures, personal behaviours etc. – it’s always felt to me that shifting things a little is a more effective way of getting to where you want to go.

This is what was behind a recent presentation in Scotland on making Self-Directed Support a reality in mental health. Rather than big pictures and sweeping strategies, the idea was to highlight small, practical things that people can do whatever part and level of the system they’re in.

(Some who think this way would therefore say: “You can’t eat an elephant all once”; to which some others reply “You can’t leap a chasm in two”. The best approaches are probably somewhere between the two – maybe a slightly nibbled elephant trying to jump really high?)

It’s why I’m endlessly fascinated by meetings. You couldn’t find a more fundamental component of running an organisation well, and yet meetings are done so universally badly it’s amazing how relatively little attention they get.

Over the last few weeks, Harvard Business Review has been running a series on effective meetings. In the spirit of this being one of the little things that can help make the big things better, here are three highlights from their series of posts:

Image from HBR

  1. Determine whether you need a meeting in the first place (see the diagram above to help with this). If you do need one, have a focused agenda, limit the people who come, and be focused
  2. End meetings well. Not (necessarily) by telling a joke, but particularly by checking the conversation is finished, checking people’s alignment, and agreeing actions and next steps
  3. For a wide variety of reasons, not having one-to-ones (especially with direct reports) might save time in the short-term, but probably creates problems in the long-run, and is not very efficient at all. Have them, and do them properly.

Why social care is like a Jackson Pollock painting

Or From Mondrian to Pollock; from systems to ecosystems: reflections on SCIE’s first social care roundtable

The kind folks over at SCIE have published some thoughts of mine on social care. Below is an extended version of that post (which might make even less sense than the shorter version)

Our concept of social care as a cohesive ‘system’ can compromise our ability to understand how complex it really is. The need to change social care to meet all future demands requires us to think in a much more sophisticated way.

Let’s start by questioning whether social care is even a ‘system’ at all. The formal definition of a system includes ideas like a fixed structure with a range of defined parts. Effects tend to follow causes, no matter how complicated the arrangements are. If one thing here is changed it predictably alters another thing there.

MondrianThis way of thinking has its attractions, not least of all to politicians, because it suggests that if only the right levers can be pulled then the right sorts of changes will happen. The picture of social care that such systems thinking paints is like a Mondrian painting: it is cohesive, makes a sort of sense, has patches of bright colour (i.e. excellence, though often at the margins) but all of which exists within a rigid structure.

Participants at a recent roundtable hosted by the Social Care Institute for Excellence suggested that a better way of thinking is to recognise the complexity of what we might call the social care ecosystem.

An ecosystem is a community of living organisms that can self-organise and interact dynamically with the environment around them. Its defining characteristic is the network of interactions between all of these factors, with effect only  often being deduced from cause only generally in retrospect.

This complex (rather than complicated) concept of social care as an ecosystem better reflects reality. Its ‘living organisms’ are the vast array of stakeholders in social care. Rather than a Mondrian picture, perhaps social care can instead best be thought of as a Jackson Pollock painting:

PollockIf we think of social care as a complex ecosystem rather than a complicated system, we need to shift our way of thinking on what needs to be ‘done’ for change to happen. As Mark Foden has said: complicated systems need a “build” mindset for change to happen, whereas a “grow” approach works best in complex ecosystems.

To change social care, we therefore need a much more sophisticated way to approach change.

What does this look like? SCIE’s roundtable identified three possibilities to start things off:

  1. Distributing power amongst all stakeholders through all aspects of co-production and by creating spaces in which the right mix of people, organisations, power, expertise, experience, styles, and cultures is brought together. (To mix metaphors, it isn’t just the ingredients that are important for change to happen, but also the way – the recipe – in which these ingredients are brought together.)
  2. Putting people at the centre of their care and support, through personalised approaches and continuing to put money more directly in their hands through Personal Budgets and Direct Payments.
  3. Spending more time and effort thinking about “scaling across” instead of scaling up, i.e. about spread rather than size. This reflection came from people recognising that approaches, particularly by smaller provider organisations, are working well precisely because their distinctive characteristics work best at a certain scale. Changing the scale risks affecting the characteristics. Rather, then, than fundamentally changing the size of an organisation (through scaling up) the smarter thing to do is think how to replicate it (scale across, or spread).

These three possibilities would work especially well in an ecosystem where the “growing” mindset is preferred to a “building” one. Whilst not abandoning entirely the levers and approaches a mechanistic way of thinking about social care has suggested in the past, now is the time to recognise the complexity of the social care ecosystem and update our approaches to change accordingly.

“Develop the virtues and talents with which every child is endowed”

From Rise of the Meritocracy*, by Michael Young:

“In the light of this approach [they] sought to give a new meaning to equality of opportunity.

“[It] should not mean equal opportunity  to rise up in the social scale, but equal opportunity for all people, irrespective of their ‘intelligence’, to develop the virtues and talents with which they are endowed, all their capacities for appreciating the beauty and depth of human experience, all their potential for living life to the full.

“The child, every child, is a precious individual, not just a potential functionary of society. The schools should not be tied to the occupational structure, bent on turning  out people for the jobs at any particular moment considered important, but should be devoted to encouraging all human talents, whether or not these are of the kind needed in a scientific world. The arts and manual skills should be given as much prominence as science and technology.

“[All] schools should have enough good teachers so that all children should have individual care and stimulus. They could then develop at their own pace to their own particular fulfilment. The schools would not segregate the like but mingle the unlike; by promoting diversity within unity, they would teach respect for the infinite human differences which are not the least of mankind’s virtues. The schools would not regard children as shaped once and for all by Nature, but as a combination of potentials which can be cultivated by Nurture.”

*Though the essay is satire, this passage clearly represents Young’s own views.

Two cultures in public services and how to bridge between the two

Image via Fanpop
Image via Fanpop

Matthew Taylor’s take on there being “two tribes” or cultures in public services is excellent, and well worth reading for anyone serious about understanding change in public services.

He describes the two tribes/cultures as follows: Networker Innovators are

budding social entrepreneurs tapping away on their devices at Impact Hubs. They tend to be young, impatient of the old ways of doing things, sceptical about traditional politics. They love big data, social media, hackathons and service design… If only they could get some start-up funding and prove their concept, it could be scaled up to change the world.

Whereas Hierarchical Managerialists are

the politicians and bureaucrats who run public service institutions and systems. They are middle aged, care worn, always tired and rarely with time for anything more than coping. Somewhere deep down they retain their idealism, but they have long since become reconciled to fulfilling their public service ethic through crisis management and marginal improvement… They are focused on local conditions, relationships and power structures. They see the biggest barrier to change not as the absence of new ideas, but the preponderance of old politics.

The result of these two tribes is that

Bright people and bright ideas fail to mature. Big systems and institutions fail to improve. Innovators add their voice to a lazy cynicism about ‘the system’ while bureaucrats pay lip service to innovation but think it is marginal to their day to day lives. Second rate ideas and second rate practices survive unchallenged, each justified by their own self-serving discourse.

Taylor’s solution to this is to bring the two systems together:

The networkers need to be challenged to understand the constraints of big systems, big budgets, complexity, risk and public accountability. The managers need to admit that many aspects of politics and public service are only the way they are due to historical accident or the positioning of vested interests.

This admittedly binary description resonates very much. My personal experience is as someone who is equally frustrated with both of the cultures described: there is clearly a significant need for large swathes of public services to change, but I sometimes find the solutions and methods proposed to secure this change both naïve and ineffective, to the point where they may undermine the very change they seek. (For example, my reflections on “innovation” demonstrate such frustration.)

(From a personal point of view, this means I don’t feel I belong to either of the cultures described, and can be misunderstood by both. I’m sure lots of folks feel they aren’t being described by either of these cultures! There are, though, a good deal of such anomalous folks around, and at different levels of the system.)

Image via StuffPoint
Image via StuffPoint

I’ve often reflected that the most successful efforts at change are when people understand the motivations and positions of “the other”; this is often, though not only, because they have been in the other person’s shoes at a previous point in their career.

This understanding seems to me to be a form of translation, bridging or linking, and it’s where I strongly believe effective change is most likely to start and be sustained in the complex world and systems of public services. It’s why the recent thinking on systems leadership – notably put forward by the Stanford Social Innovation Review – is something I’ve blogged on before: it gives concrete form to what these ‘translating’ / ‘bridging’ / ‘linking’ activities are. They include:

  • Seeing reality through the eyes of people very different from yourself
  • Building relationships based on deep listening and building networks of trust and collaboration
  • Having an ability to see the larger system and so building a shared understanding of complex problem
  • Fostering reflection and conversation that can challenge assumptions or existing mental models
  • Shifting the collective focus from reactive problem solving to co-creating the future… not just building inspiring visions but facing difficult truths about the present reality and learning how to use the tension between vision and reality to inspire truly new approaches.
  • Re-directing attention to see that problems “out there” are “in here” also, recognising that we are all part of the systems we seek to change
  • Re-orienting strategy by creating the space for change and enabling collective intelligence and wisdom to emerge: instead of trying to make change happen we focus on creating the conditions that can produce change
  • Working through a disciplined stakeholder engagement process, the nature of which can’t be predicted in advance
  • Transforming relationships among people who shape systems, rather than just working on systems themselves.

Talking with a fellow frustrated friend about this, we realised we both found Taylor’s analysis heartening. Understanding a problem goes a long way towards solving it, and being explicit about both the “two tribes” and adding some ideas as to how to bridge the gaps between the two hopefully helps to shift us to more effective change in public services.

£1.25billion for children’s mental health: what’s it worth and what’s it for?

When large sums of money are announced in public services there are two questions to ask yourself: (1) What is the money worth in the context of the existing system?; and (2) What will it be spent on?

Over the weekend, the Lib Dems said there will be £1.25billion for “children’s mental health services”. This money is to be over 5 years, equating to £250million per year.

Piecing together various bits of news (BBC, Mind) it seems some of this funding will also go on supporting pregnant women and new mothers with their mental health (i.e. perinatal mental health services) and doubling funding for veterans’ mental health services[1].

Let’s answer our first self-posed question: what is this worth?

down graphSpending specifically on children’s mental health services has been cut by 6.4% since 2010. In 2009/10 some £766m was spent on children’s mental health, which by 2012/13 was £717m – a cut of £49m.

As NHS England and the Minister for Care Services, as source of these figures, make clear, this is only direct spend on children’s mental health services. The figures don’t include local authority spend on the same, where we know 60% of local councils have frozen or cut their children’s mental health spend since 2010/11. Nor do these figures include spending on adult mental health. We know this is relevant because (a) this is where perinatal and veterans mental health funding comes from, and (b) problems in children’s mental health mean that young people are often treated on adult mental health wards. Looking only at local authority mental health spending, this has been cut by £210m since 2009/10. (The question of levels of adult mental health spending in the NHS is questionable; at best, it has stayed static over the last year having been cut by 2.3% in real-terms between 2011-12 and 2013-14.)

In this context, £250m a year doesn’t seem so much, though any money is, of course, welcome[2].

What about our second question: what will this money be spent on?

Inevitably, given its provenance ahead of the Budget, details of how this money will be spent are unclear. The intention, though, seems to be for it to go on “early intervention schemes to stop children developing serious and potential fatal mental illnesses”. Such early intervention is to include therapy sessions, family support work, better training for clinicians and the development of help via websites and online apps.

This is better than I expected, though we should raise a word of warning: given the almost universal focus on children’s inpatient beds it will be hard for providers to not funnel this money into more inpatient beds. We should keep a close eye on where this money goes.

One suggestion I’d like to see is that at least some of the money should be ear-marked for use as Personal Health Budgets, including as part of the Integrated Personal Commissioning programme. Both the PHBs and IPC programmes have explicit focus on mental health and children and young people, and we know that this route leads to more control and more flexible solutions that can meet individual needs. We also know it can join up fragmented systems, and is likely to divert money away from institutionally biased provision.

Money is a blunt tool. Even if it’s questionable whether the amount of money being pledged to something is worth much, we should also ask how it will be spent and ensure it’s used not just to prop up more of what went before. The money to be pledged in the Budget on children’s mental health is a particularly acute case in point.

Notes:

[1] – The Lib Dem press release also says funding will go to “extend access to services for children under five and those with autism and learning disabilities”, which is strange to say the least.

[2] – I think it is worth noting just how difficult it is to get hold of spending figures on children’s mental health. The Health Select Committee’s recent report on children’s mental health services noted (paragraph 15 here http://www.publications.parliament.uk/pa/cm201415/cmselect/cmhealth/342/342.pdf (pdf)) there is a “lack of information about service provision, including demand,  access and expenditure” and that the best source of such information is currently voluntary. The spending figures found by Young Minds took an FOI request!

The Greens may have something to say, but Natalie Bennett’s performances put them in a double bind

Natalie Bennett has given a second terrible interview, this time to LBC on the topic of housing. (The first was on Citizen’s Income to the Sunday Politics.)

Yesterday’s mishap is terrible from both a content and a style point of view: content because she doesn’t appear to know basic numbers behind her party’s policy on housing; style because the pauses, coughs, erms, and “right, yes”-es don’t convey any confidence to listeners.

There’s another reason why this is terrible, though: the Green Party might have something different to say when it comes to politics. This is, after all, the reason why Bennett is being interviewed on LBC and the Daily Politics and why so many people are therefore aware of how badly her interviews are going. But we don’t know what it is the Green Party has to say because everyone is focusing on what a bad job they are doing in saying it.

Where does this leave us?

At the individual leve, I don’t know Bennett well enough to understand whether these interviews are just a blip or whether she isn’t necessarily cut out to be leader of a political party.

At the party level I can’t help but think that the Greens need more political professionals behind them – like strategists, media managers, policy people etc. – to try and get their house in order and prevent / minimise this type of thing happening again and again.

The irony, of course, is that whilst having more of these things might make them more effective it would also make them a bit more like the bigger political parties they’re currently the antidote to.

It’s a double-bind, and the quality of our political debate may be the worse for it.